Provider Data Management / Credentialing Verification Organization (PDM/CVO) Solution New Launch Date of 2026.
Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.
Topics Related to Medicaid Direct
Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
Billing Requirements for Medicaid Direct Providers
Look for details on training in June related to these changes.
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
Recent State Plan Amendment outlines duties of a responsible third party